Pharmacy Operations Representative – Medicaid

Health Care Service Corporation

Pharmacy Operations Representative managing pharmacy-related inquiries and claims for Medicaid at HCSC. Collaborating with pharmacy teams, members, and vendors to ensure compliance and resolution.

Posted 6/17/2026full-timeAlbuquerque • Illinois, New Mexico • 🇺🇸 United StatesMid-LevelSenior💰 $38,100 - $80,000 per yearWebsite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Pharmacy TechnicianCertified Pharmacy Technician (CPhT)Drug information skillsManaged care customer serviceUtilization Management (UM)Clinical ServicesClaims resolutionProcess facilitationStep TherapyPrior-authorization

Soft Skills

Verbal communicationWritten communicationOrganizational skillsCollaborationProblem-solvingMulti-tasking

Tools & Technologies

MS WordMS ExcelMS AccessDatabase software

Certifications & Qualifications

Licensed Pharmacy TechnicianCertified Pharmacy Technician (CPhT)

Industry Keywords

PharmacyHealth careManaged careRetail PharmacyHospital PharmacySpecialty PharmacyPharmacy Benefits ManagerHealth PlanClaims submissionFederal and state regulations

About the role

Key responsibilities & impact

Provide assistance to pharmacists, pharmacy team, care coordinators, and the customer service team in the resolution of pharmacy-related issues to include claims
Work closely with internal departments and external vendors to evaluate and resolve issues
Support processes to ensure federal and state regulations and program requirements are met and maintained
Communicate pharmacy related written and telephone inquiries with members, providers, pharmacies, and groups regarding benefits

Requirements

What you’ll need

Licensed and unrestricted Pharmacy Technician/Certified Pharmacy Technician (CPhT)
Bachelor's degree in Business or a related health care field OR 4 years work experience in a pharmacy/health care/managed care industry
Verbal and written communication skills
Managed care customer service experience
Proficiency of MS product suite; Word, Excel, Access, and database software
Drug information skills
Handle multiple tasks and strong organizational skills.
Retail, Hospital, Specialty Pharmacy, Pharmacy Benefits Manager, Health Plan experience (preferred)
Telephone support to include members inquiries, providers, pharmacies, and groups regarding benefits (preferred)
Support through written and digital channels (preferred)
Effectively working across / collaborating with internal stakeholders such as Customer Service Team, PBM/Pharmacy, Providers, members to resolve pharmacy related gaps in care, coverage & claims submission issues (preferred)
Facilitate process for clinical & benefit overrides, Step Therapy and prior-authorization efforts in the PBM claims systems for Utilization Management (UM) and Clinical Services (preferred)

Benefits

Comp & perks

Health insurance
401(k) savings plan
Pension plan
Paid time off
Paid parental leave
Disability insurance
Supplemental life insurance
Employee assistance program
Paid holidays
Tuition reimbursement